|
Aranesp Administration 100mcg (Peritoneal Dialysis)
|
Facility
|
IP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,564.98 |
| Max. Negotiated Rate |
$2,938.33 |
| Rate for Payer: Aetna Commercial |
$2,874.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,746.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,692.74
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,938.33
|
| Rate for Payer: Health EOS Commercial |
$2,842.52
|
| Rate for Payer: HFN Commercial |
$2,938.33
|
| Rate for Payer: Multiplan Commercial |
$2,555.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,938.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,564.98
|
| Rate for Payer: Quartz Commercial |
$1,916.30
|
| Rate for Payer: WEA Trust Commercial |
$1,756.61
|
| Rate for Payer: WPS Commercial |
$2,365.59
|
|
|
Aranesp Administration 100mcg (Peritoneal Dialysis)
|
Facility
|
OP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$2,938.33 |
| Rate for Payer: Aetna Commercial |
$2,874.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,746.70
|
| Rate for Payer: Aetna Managed Medicare |
$894.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,076.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,596.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,533.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,692.74
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,938.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$2,842.52
|
| Rate for Payer: HFN Commercial |
$2,938.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,395.38
|
| Rate for Payer: Multiplan Commercial |
$2,555.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,916.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,938.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,564.98
|
| Rate for Payer: Quartz Commercial |
$2,076.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,916.30
|
| Rate for Payer: The Alliance Commercial |
$1,596.92
|
| Rate for Payer: WEA Trust Commercial |
$1,756.61
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 25mcq (Dialysis)
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 25mcq (Dialysis)
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
Aranesp Administration 25mcq (Peritoneal Dialysis)
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$631.90 |
| Max. Negotiated Rate |
$1,186.43 |
| Rate for Payer: Aetna Commercial |
$1,160.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.49
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,186.43
|
| Rate for Payer: Health EOS Commercial |
$1,147.74
|
| Rate for Payer: HFN Commercial |
$1,186.43
|
| Rate for Payer: Multiplan Commercial |
$1,031.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.43
|
| Rate for Payer: Quartz Beloit One Network |
$631.90
|
| Rate for Payer: Quartz Commercial |
$773.76
|
| Rate for Payer: WEA Trust Commercial |
$709.28
|
| Rate for Payer: WPS Commercial |
$955.17
|
|
|
Aranesp Administration 25mcq (Peritoneal Dialysis)
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,186.43 |
| Rate for Payer: Aetna Commercial |
$1,160.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.06
|
| Rate for Payer: Aetna Managed Medicare |
$361.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$838.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$644.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$619.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.49
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,186.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,147.74
|
| Rate for Payer: HFN Commercial |
$1,186.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$967.20
|
| Rate for Payer: Multiplan Commercial |
$1,031.68
|
| Rate for Payer: NAPHCARE Commercial |
$773.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.43
|
| Rate for Payer: Quartz Beloit One Network |
$631.90
|
| Rate for Payer: Quartz Commercial |
$838.24
|
| Rate for Payer: Quartz Medicare Advantage |
$773.76
|
| Rate for Payer: The Alliance Commercial |
$644.80
|
| Rate for Payer: WEA Trust Commercial |
$709.28
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 40mcq (Dialysis)
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.17 |
| Max. Negotiated Rate |
$1,860.98 |
| Rate for Payer: Aetna Commercial |
$1,820.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,739.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.08
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,860.98
|
| Rate for Payer: Health EOS Commercial |
$1,800.29
|
| Rate for Payer: HFN Commercial |
$1,860.98
|
| Rate for Payer: Multiplan Commercial |
$1,618.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.98
|
| Rate for Payer: Quartz Beloit One Network |
$991.17
|
| Rate for Payer: Quartz Commercial |
$1,213.68
|
| Rate for Payer: WEA Trust Commercial |
$1,112.54
|
| Rate for Payer: WPS Commercial |
$1,498.23
|
|
|
Aranesp Administration 40mcq (Dialysis)
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,860.98 |
| Rate for Payer: Aetna Commercial |
$1,820.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,739.61
|
| Rate for Payer: Aetna Managed Medicare |
$566.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.08
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,860.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,800.29
|
| Rate for Payer: HFN Commercial |
$1,860.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,517.10
|
| Rate for Payer: Multiplan Commercial |
$1,618.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.98
|
| Rate for Payer: Quartz Beloit One Network |
$991.17
|
| Rate for Payer: Quartz Commercial |
$1,314.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.68
|
| Rate for Payer: The Alliance Commercial |
$1,011.40
|
| Rate for Payer: WEA Trust Commercial |
$1,112.54
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 40mcq (Peritoneal Dialysis)
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.17 |
| Max. Negotiated Rate |
$1,860.98 |
| Rate for Payer: Aetna Commercial |
$1,820.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,739.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.08
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,860.98
|
| Rate for Payer: Health EOS Commercial |
$1,800.29
|
| Rate for Payer: HFN Commercial |
$1,860.98
|
| Rate for Payer: Multiplan Commercial |
$1,618.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.98
|
| Rate for Payer: Quartz Beloit One Network |
$991.17
|
| Rate for Payer: Quartz Commercial |
$1,213.68
|
| Rate for Payer: WEA Trust Commercial |
$1,112.54
|
| Rate for Payer: WPS Commercial |
$1,498.23
|
|
|
Aranesp Administration 40mcq (Peritoneal Dialysis)
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,860.98 |
| Rate for Payer: Aetna Commercial |
$1,820.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,739.61
|
| Rate for Payer: Aetna Managed Medicare |
$566.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.08
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,860.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,800.29
|
| Rate for Payer: HFN Commercial |
$1,860.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,517.10
|
| Rate for Payer: Multiplan Commercial |
$1,618.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.98
|
| Rate for Payer: Quartz Beloit One Network |
$991.17
|
| Rate for Payer: Quartz Commercial |
$1,314.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.68
|
| Rate for Payer: The Alliance Commercial |
$1,011.40
|
| Rate for Payer: WEA Trust Commercial |
$1,112.54
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 60mcq (Dialysis)
|
Facility
|
IP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$939.19 |
| Max. Negotiated Rate |
$1,763.38 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,015.86
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,763.38
|
| Rate for Payer: Health EOS Commercial |
$1,705.88
|
| Rate for Payer: HFN Commercial |
$1,763.38
|
| Rate for Payer: Multiplan Commercial |
$1,533.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.38
|
| Rate for Payer: Quartz Beloit One Network |
$939.19
|
| Rate for Payer: Quartz Commercial |
$1,150.03
|
| Rate for Payer: WEA Trust Commercial |
$1,054.20
|
| Rate for Payer: WPS Commercial |
$1,419.66
|
|
|
Aranesp Administration 60mcq (Dialysis)
|
Facility
|
OP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,763.38 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.38
|
| Rate for Payer: Aetna Managed Medicare |
$536.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,245.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,015.86
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,763.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,705.88
|
| Rate for Payer: HFN Commercial |
$1,763.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.54
|
| Rate for Payer: Multiplan Commercial |
$1,533.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.38
|
| Rate for Payer: Quartz Beloit One Network |
$939.19
|
| Rate for Payer: Quartz Commercial |
$1,245.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.03
|
| Rate for Payer: The Alliance Commercial |
$958.36
|
| Rate for Payer: WEA Trust Commercial |
$1,054.20
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
Aranesp Administration 60mcq (Peritoneal Dialysis)
|
Facility
|
IP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$939.19 |
| Max. Negotiated Rate |
$1,763.38 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,015.86
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,763.38
|
| Rate for Payer: Health EOS Commercial |
$1,705.88
|
| Rate for Payer: HFN Commercial |
$1,763.38
|
| Rate for Payer: Multiplan Commercial |
$1,533.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.38
|
| Rate for Payer: Quartz Beloit One Network |
$939.19
|
| Rate for Payer: Quartz Commercial |
$1,150.03
|
| Rate for Payer: WEA Trust Commercial |
$1,054.20
|
| Rate for Payer: WPS Commercial |
$1,419.66
|
|
|
Aranesp Administration 60mcq (Peritoneal Dialysis)
|
Facility
|
OP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$1,763.38 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.38
|
| Rate for Payer: Aetna Managed Medicare |
$536.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,245.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,015.86
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,763.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$1,705.88
|
| Rate for Payer: HFN Commercial |
$1,763.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.54
|
| Rate for Payer: Multiplan Commercial |
$1,533.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.38
|
| Rate for Payer: Quartz Beloit One Network |
$939.19
|
| Rate for Payer: Quartz Commercial |
$1,245.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.03
|
| Rate for Payer: The Alliance Commercial |
$958.36
|
| Rate for Payer: WEA Trust Commercial |
$1,054.20
|
| Rate for Payer: WPS Commercial |
$7.54
|
|
|
ARBC CPD AS5 500
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.15
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$339.30
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
ARBC CPD AS5 500
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
ARBC CPD AS5 LV
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052820
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
ARBC CPD AS5 LV
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052820
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.15
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$339.30
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Professional
|
Both
|
$438.03
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$432.77 |
| Rate for Payer: Aetna Commercial |
$432.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.77
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$432.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$414.55
|
| Rate for Payer: HFN Commercial |
$432.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$364.44
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$432.77
|
| Rate for Payer: Quartz Beloit One Network |
$200.44
|
| Rate for Payer: Quartz Commercial |
$259.66
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$250.55
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Facility
|
IP
|
$438.02
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$223.21 |
| Max. Negotiated Rate |
$419.10 |
| Rate for Payer: Aetna Commercial |
$409.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.44
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$419.10
|
| Rate for Payer: Health EOS Commercial |
$405.43
|
| Rate for Payer: HFN Commercial |
$419.10
|
| Rate for Payer: Multiplan Commercial |
$364.43
|
| Rate for Payer: Preferred Network Access Commercial |
$419.10
|
| Rate for Payer: Quartz Beloit One Network |
$223.21
|
| Rate for Payer: Quartz Commercial |
$273.32
|
| Rate for Payer: WEA Trust Commercial |
$250.55
|
| Rate for Payer: WPS Commercial |
$337.41
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Facility
|
OP
|
$438.02
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$419.10 |
| Rate for Payer: Aetna Commercial |
$409.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.77
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$419.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$405.43
|
| Rate for Payer: HFN Commercial |
$419.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$364.43
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$419.10
|
| Rate for Payer: Quartz Beloit One Network |
$223.21
|
| Rate for Payer: Quartz Commercial |
$296.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$341.66
|
| Rate for Payer: WEA Trust Commercial |
$250.55
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$337.41
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$60.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
ARCH BAR
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
